Skin pain: A symptom to be investigated
Authors: Gil Yosipovitch, Marketa Saint Aroman, Charles Taieb, Francesca Sampogna, Fabienne Carballido, Adam Reich
Journal: Journal of the American Academy of Dermatology (2022)

To the Editor: Skin pain is an important symptom in dermatological conditions. It is associated with low quality of life (QoL) and high psychological distress, including suicidal ideation.1Halvorsen J.A. Dalgard F. Thoresen M. Bjertness E. Lien L. Itch and pain in adolescents are associated with suicidal ideation: a population-based cross-sectional study.Acta Derm Venereol. 2012; 92: 543-546Crossref PubMed Scopus (48) Google Scholar Chronic skin pain was reported by 36.4% of French dermatological patients,2Misery L. Saint Aroman M. Zkik A. et al.Chronic pain in patients with skin disorders.Acta Derm Venereol. 2017; 97: 986-988Crossref PubMed Scopus (11) Google Scholar with the highest prevalence in those with leg ulcers, atopic dermatitis, and psoriasis. In a group of patients with skin diseases in general practice,3Verhoeven E.W.M. Kraaimaat F.W. Van De Kerkhof P.C.M. et al.Prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases in general practice.Br J Dermatol. 2007; 156: 1346-1349Crossref PubMed Scopus (90) Google Scholar the prevalence was 23%. Pain has been reported as the most frequent symptom associated with atopic dermatitis, after itching and sleep difficulties,4Wittkowski A. Richards H.L. Griffiths C.E.M. Main C.J. Illness perception in individuals with atopic dermatitis.Psychol Health Med. 2007; 12: 433-444Crossref PubMed Scopus (54) Google Scholar and it is frequent in psoriasis, with prevalence up to 43.6%,5Patruno C. Napolitano M. Balato N. et al.Psoriasis and skin pain: instrumental and biological evaluations.Acta Derm Venereol. 2015; 95: 432-438Crossref PubMed Scopus (37) Google Scholar and in hidradenitis suppurativa. However, skin pain may be also present in the general population without dermatological disease and may be an early sign of a not-yet-diagnosed skin condition but also a symptom of nondermatological diseases, such as fibromyalgia or peripheral neuropathy. The aim of the present observational study was to investigate the presence of skin pain (by the question "do you feel pain in your skin?") in persons with and without skin conditions (both inflammatory and noninflammatory). The study was conducted on a representative sample (guaranteed by the method of quotas stratified by age and gender with strict cross-quotas, regions, and income levels) of the population of Canada, China, France, Germany, Italy, and Spain, aged from 18 to 75 years, extracted from the Epi Database (https://kantarhealth.com/docs/datasheets/kh-epi-database, last accessed on March 30, 2022). On a total of 13,138 adults, 11.2% reported skin pain. Among those who reported at least 1 skin condition (n = 3450), the frequency of skin pain was 24.3%, while in the 9688 participants with no skin conditions, it was 6.6% (P < .001, χ2 test). There were differences in pain prevalence by age, country, and skin disease (the 5 most frequent were analyzed), and prevalence increased with the increasing number of skin conditions (Table I). When a dermatological condition was present, the mean duration of skin pain was significantly higher, and permanent or unbearable pain was more frequent than in patients with no skin disease (Table II). Also, the impact of skin pain on daily and work activities was higher in participants with skin conditions. Sensations and symptoms associated with pain differed between the 2 groups. Among patients with skin conditions reporting pain, 53.5% had a Dermatology Life Quality Index (DLQI) score >10 (ie, low dermatology-related QoL) compared to 14.7% in participants with no skin pain (P < .001, χ2 test). QoL was particularly impaired when pain was permanent, unbearable, or associated with at least 1 sensation or symptom.Table IFrequency of skin pain and mean VAS pain scores in different subgroups of patientsVariableLevelTotal nPain n (%)P (χ2 test)RRVAS pain (range 0-10)P (χ2 test)Overall13,1381478 (11.2)5.3 (2.2)SexMale6577772 (11.7).076Ref.5.3 (2.2).758Female6561706 (10.8)0.925.4 (2.2)CountryCanada2011214 (10.6)<.0011.585.2 (2.3)<.001China3050422 (13.8)2.065.5 (2.3)France2000179 (9.0)1.344.6 (2.2)Germany2037385 (18.9)2.825.8 (2.2)Italy2000134 (6.7)Ref.5.2 (2.1)Spain2040144 (7.1)1.065.2 (2.0)Age (y)15-303032493 (16.3)<.001Ref.5.2 (2.3).20231-453506490 (14.0)0.865.4 (2.1)46-603698305 (8.2)0.505.5 (2.2)>602902190 (6.5)0.405.4 (2.2)Skin diseases (SD)No9688639 (6.6)Ref.5.1 (2.2)Yes3450839 (24.3)<.0013.685.6 (2.1)<.0011 SD2461451 (18.3)2.775.2 (2.3)2 SD751252 (33.6)5.095.7 (2.0)3 SD17589 (50.9)7.716.0 (2.0)>3 SD6347 (74.6)<.00111.306.4 (2.0)<.001Skin diseaseCompared to « no skin disease »Compared to « no skin disease »Compared to patients without this diseaseAcne60693 (15.3)<.0012.355.0 (2.2).504Eczema717130 (18.1)<.0012.795.3 (2.1).346Hand eczema13839 (28.3)<.0014.355.4 (1.9).472Psoriasis32061 (19.1)<.0012.945.1 (2.3).937Rosacea16632 (19.3)<.0012.974.8 (2.1).489 Open table in a new tab Table IICharacteristics of skin pain in participants with and without skin diseaseNo skin diseaseWith skin diseaseP (χ2 test)Mean duration (mo)19.031.3.002 (t-test)N%N%Permanent26341.241849.8<.001Transient37658.842150.2Unbearable.006 Yes51077.570383.2 No14822.514216.8Localization Face16125.228534.0<.001 Hands26441.336243.1.392 Body31449.143251.5.334It does not interfere with any activity26140.825029.8<.001It interferes with professional activities12719.924729.4<.001It interferes with family activities16425.720824.8.815It interferes with daily activities17327.134140.6<.001Sensations None19831.013015.5<.001 Burning24538.343652.0<.001 Cold14422.520724.7.271 Electric discharge14422.524829.6.001Symptoms None15924.9718.5<.001 Tingling16225.325830.7.014 Stinging18929.634541.1<.001 Numbness11818.521826.0<.001 Itch18128.341949.9<.001 Open table in a new tab Limitations of the study are that it is possible that some of the patients may perceive skin pain with other types of pain, that we do not know if the pain was felt on the surface of a normal-looking skin or a lesional skin, and that the dermatological diagnosis was not verified by a clinical examination. In conclusion, skin pain is a frequent symptom in patients with dermatological conditions and should be considered in the management of the disease, in order to improve a patient's QoL and well-being. Marketa Saint Aroman and Fabienne Carballido are employed by Pierre Fabre. The authors thank Catherine Baissac and Helene Passerini, who supported and largely participated in this work, the study participants, as well as Michael Fijnvandraat for writing assistance.